Provider Demographics
NPI:1912069550
Name:KERENDI, FARNAZ S (PHD)
Entity Type:Individual
Prefix:
First Name:FARNAZ
Middle Name:S
Last Name:KERENDI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17075 DEVONSHIRE BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5408
Mailing Address - Country:US
Mailing Address - Phone:818-368-8929
Mailing Address - Fax:818-368-8940
Practice Address - Street 1:17075 DEVONSHIRE STREET
Practice Address - Street 2:STE 204
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5408
Practice Address - Country:US
Practice Address - Phone:818-368-8929
Practice Address - Fax:818-368-8940
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP17344Medicare PIN